Healthcare Provider Details

I. General information

NPI: 1518206465
Provider Name (Legal Business Name): ACTION LIFE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 FORT ST #4
BUFFALO WY
82834-2424
US

IV. Provider business mailing address

PO BOX 1066
BUFFALO WY
82834-1066
US

V. Phone/Fax

Practice location:
  • Phone: 307-217-2414
  • Fax:
Mailing address:
  • Phone: 307-217-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANA L WILSON-HILL
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 307-217-2141